Nahit Ata

Role of lymphadenectomy in disease-free and overall survival on low risk endometrium cancer patients

OBJECTIVES Evaluation of the effect of lymphadenectomy in disease-free and overall survival on the low risk corpus cancer. MATERIAL AND METHODS Between 1994 and 2012, a total of 257 patients with endometrioid type, grade 1 or 2, myometrial invasion < 1/2, no intraoperative evidence of macroscopic extrauterine spread was treated surgically. Pelvic lymphadenec-tomy was performed in 184 cases, and not performed in 73 cases. RESULTS There was no difference between two groups about tumor sizes. Also lymphovascular space invasion and histo-logic grade of two groups were similar. Omission of LA did not worsen DFS and OS in early stage low risk corpus cancer. CONCLUSIONS Patients who have low risk corpus cancer, can be treated optimally with hysterectomy only.

Prognostic factors of primary fallopian tube carcinoma

Aim of the study Fallopian tube cancer is very rare in the literature and so there are not enough data about the therapeutic approaches. The approaches are generally determined in accordance with the data obtained from ovarian cancer. Many prognostic factors have been investigated in an effort to better estimate patient outcome. Stage, age, and residual tumor after surgery are consistently important prognostic factors. In this study, we aimed to evaluate the prognostic factors and survival rates of primary fallopian tube cancer (PFTC), which is rare among gynecological cancers. Material and methods Thirty-eight patients with a diagnosis of PFTC were identified through the gynecologic oncology service database of our Research and Training Hospital in the period 1995–2013. Clinicopathological and surgical data were collected. All patients were evaluated for survival and disease-free survival between the dates specified. Results A significant relationship and correlation was found between optimal surgery and life expectancy. Better results were obtained in patients treated with optimal surgery. The survival probability was found to be higher in patients with lower CA-125 levels and serous histologic type adenocarcinoma. Conclusions Stage is one of the factors affecting the survival probability. We determined that the pathological type of tumor, the diameter of residual tumor remaining after surgery, tumor grade, preoperative CA-125 levels and presence of ascites affect the survival probability.

Should the visceral peritoneum be closed over mesh in abdominal sacrocolpopexy

INTRODUCTION AND HYPOTHESIS Peritonisation of mesh during Abdominal sacrocolpopexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking. In this study; we aimed to investigate whether the mesh peritonisation is clinically significant or not. MATERIAL METHOD Thirty-four patients who were operated for the reason of pelvic organ prolapse were included in the study. Patients were divided into two groups by retrospective scanning from the files and surgical reports. Group 1 patients consisted of those who underwent peritonisation and group 2 patients consisted of those who did not in abdominal sacrocolpopexy. RESULTS Operative time and the amount of blood lost were statistically less in the group 2. Postoperative pain and analgesic drug requirements were obviously higher in the group 1. Postoperative De novo dyspareunia and urinary urgency were higher in the group 1. There were no statistical differences between the groups in terms of other complications. CONCLUSION We noticed that there was no difference between the patients who were peritonized and those who were not in terms of postoperative complications.

Estimation of the prevalence and distribution of HPV genotypes and identification of related risk factors among Turkish women

Aim of the study The present study aims to estimate the prevalence and distribution of HPV genotypes and identify related risk factors among Turkish women. Material and methods 11 624 Turkish women attending our gynaecological clinic and expressing a desire for access to cervical cancer screening were assessed during the years 2014–2016. Cervical specimens were collected and transported using the HC2 HPV DNA Collection Device (consisting of a cervical brush and digene Specimen Transport Medium). Results Among these 11 624 individuals, positive HPV test results were obtained for 325 (2.79%), and negative results were observed for 11 299 (97.2%). The vast majority of patients were between the 3rd and 5th decades and the mean age of the patients was 44 ±9.12 (range 27–66). Among the HPV-positive women, 205 were positive for a single HPV type (205/325 = 63.1% of HPV infections; 205/11624 = 1.76% of all samples) and 120 were positive for multiple types (120/325 = 36.9% of HPV infections; 120/11624 = 1.03% of all samples). The four most prevalent high-risk types were HPV 16, 31, 51 and 52, with frequencies of 11.25%, 7.83%, 6.06% and 3.16%, respectively. Conclusions There appears to be geographic variation in the distribution of HPV genotypes. In this study, the four most prevalent high-risk types were HPV 16, 31, 51 and 52, with frequencies of 11.25%, 7.83%, 6.06% and 3.16%, respectively.

Outcomes of the patients diagnosed incidentally appendicitis during cesarean section

OBJECTIVES Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. MATERIAL AND METHODS The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016. RESULTS Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean dia-meter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. CONCLUSIONS Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeons preference and experience.

Intrahepatic cholestasis of pregnancy and fetal outcomes. Mini review

Intrahepatic cholestasis of pregnancy (ICP), a pregnancy-related liver disease, leads to complications for both mother and fetus. It is the most common liver disease in pregnant women. The incidence of ICP has varied widely in different reports (ranging from 0.1 to 15.6%), for reasons that are incompletely understood. Hormonal, immunologic, genetic, environmental and alimentary factors have been implicated in the etiology of ICP. Although a clear correlation between elevated levels of maternal serum bile acids and deficient fetal outcome has been established in clinical practice, the underlying mechanisms remain elusive. Here we present a mini literature review about intrahepatic cholestasis of pregnancy and fetal outcomes.

Hormonotherapy in the Management of Recurrent Ovarian Cancer

The treatment of patients with recurrent ovarian carcinoma after failure of first and second-line chemotherapy is still debated. Chemical agents used for third and fourth-line therapy usually yield poor results with severe toxic side effects. Objective: To summarize our experience with Tamoxifen and megestrol in the treatment of patients with recurrent ovarian cancer. Methods: From September 1995 to June 2015 we administered Tamoxifen and Megestrol to 29 patients with advanced and recurrent epithelial ovarian cancer. Results: There was no complete responder in patients taking tamoxifen. One (1/15) patient who used tamoxifen achieved a partial response lasting 12 months. There was also no complete responder in patients taking megestrol. Three patients (%21.4) who used Megestrol achieved a partial response but eleven % 78.57 (11/14) had no response from the treatment. Conclusion: Hormonotherapy has approximately %10 answer rate. There is a correlation between the answer given to hormonotherapy and the existence of hormone receptors. In general, the answer given to hormonotherapy is at a low level. At present, it is used as an alternative treatment option in the patients who do not answer to chemotherapy or who cannot tolerate the toxic effects of chemotherapy.

Tetralogy of Fallot Complicated With Preeclampsia After Three Cardiac Operations

Tetralogy of Fallot (ToF) is the most common form of cyanotic congenital heart diseases and without corrective surgery, natural survival rate into the fourth decade was only about 3%. In pregnant patients with repaired ToF, pregnancy-related physiological changes is more difficult to tolerate compared to healthy pregnant woman. ToF rarely be associated with preeclampsia. Discussed below a case of a 20 year old woman with repaired ToF Complicated with Preeclampsia After Three Cardiac Operations.